[Unknown Member]

Im an MSK attending. I was in the same position as you in residency. In fact I was between MSK, Neuro, and Body. I honestly liked all 3 and couldnt decide. I liked reading most of radiology except breast. So it was like, do you prefer reading MSK mri studies, neuro mri studies, or body CTs? I like reading all 3, in fact on the work list on call etc I would frequently bounce between all 3 since it was a combined call. To this day I still cannot see any real difference in the enjoyability between the 3, they are all just scrolling through cases trying to pick up findings at the end of the day. Whats the difference between scrolling through a knee vs the pelvis vs the head? Other than the pathology of course

I picked MSK because I was told by others that body was basically unnecessary and you should be comfortable with it after residency (which I dont think is true, body CT yes but not prostate, rectal, liver mri etc). Neuro was a close second but it seemed to high stakes and I was concerned about the medmal (also incorrect, statistically MSK plain films have the highest malpractice rate per study, excluding breast imaging of course).

In the end I do like MSK but I think neuro is a bit cooler in that the anatomy is more complex and has to do with functional aspects of the brain, etc. The academic reading and talking points are more interesting. Ultimately, I do body neuro and MSK as a generalist so the choice probably didnt matter anyway. I dont read some high level neuro and body cases but do read them for MSK, which is the only difference, but those high level cases are rare anyway. If I was neuro, I guess Id read the occasional Tbone CT instead of the occasional hand/finger MRI, but most of my signed today list would be the same.

To answer some of your questions though:
neuro is probably more desirable right now. There seems to be a surplus of MSK rads at the moment, not sure why exactly but I see a lot more job postings looking for neuro

Doubt any difference in call/salary in PP. most PP groups everyone reads everything, so there isnt a seperate neuro call. A few groups do have seperate neuro call with a dedicated neurorad on, so that may affect call, though I wonder if it makes it better or worse. Its pretty atypical though

Since most PP groups have you as general, plain films are probably about the same. You might prefer to read them and thus take more, whereas neuro youd probably gravitate more to the neuro list/studies. You could choose to do it the opposite way at most combined list places. It varies on group structure as well, if there are dedicated MSK rotation. If you are acting as a subspecialist rad in the rare group that supports it, you can expect more plain films

As neuro, essentially the same as above except you would expect more neuro CT/mri if there is a subspecialty focus in the group. In terms of total mris read, MSK vs neuro imagers, its probably about the same. Mostly a function of what the volume is like for each subspecialty and how many people are in the group with training in each

[Unknown Member]

In PP, you’ll likely be reading a lot of everything regardless;  the choice matters less than you think. We hired a neuro fellow who also did a year of chest fellowship, and put him to work doing breast half the time. (And he’s been a great breast imager, on top of everything else he does.)  When it comes time to consider job offers, don’t be surprised if you find yourself flexible on what organ systems/modalities you will read and are more focused on location, income, vacation, daily work hours, busy-ness, and overall group harmony/ stability.  If someone is turning down great PP jobs in order to find a job that lets’ them read >90% neuro or chest, they come to regret their priorities. 
 
As far as which is more likely to land you a job – i.e. “marketable” – I don’t think anyone here can answer that because it depends on what a group happens to need:  One group in town happens to need a neuro guy more at the time you are applying;  another group happens to need nuclear medicine; yet another needs an MSK guy. In two years, all that could change because of a retiring partner. Luck of the draw. You can’t predict it.  On the other hand, if you say what is more marketable, pediatric radiology or breast – that we can generalize and say breast. But neuro and MSK are close. 

[papp8_333]

I’m not OP but also considering both of these fellowships. Obviously this is going to be practice dependent, but would you say neuro or MSK is more procedural heavy out “in the real world?” It’s hard not to generalize how an academic department translates to other practice environments. For example, our MSK dept is super heavy on procedures, while neuro does a handful of LPs but not a whole lot else. 

[6541165]

Several people in my residency class are between neuro and MSK. Interesting that the two typically come together. What do they have in common? Complex anatomy for people who enjoy that?

[luciairegui]

In private practice it’s probably about the same, LP vs arthrogram. Neither is very procedurally heavy but maybe a slight bent towards MSK – this could vary a lot. In some practices IR will do everything.
 
MSK will often end up being a lot more plain film vs neuro being more cross sectional work. And some places don’t have the MSK volume so you may read more non-MSK stuff.
 
In the end, it’s best to go into the one you find yourself liking more. Do you like small joint anatomy more or temporal bone anatomy. A version/torsion study or a epilepsy workup.

[pankajkaira1982_700]

Neurorad here. Same situation many years ago. Don’t do neuro. If you miss a very small finding it is catastrophic for the patient. You will always be needed for call purposes (stroke, bs cauda equina)
 
As for MSK, what is the worse that can happen? Pt will continue to experience pain. Experienced orthopods don’t need your read whether or not they decide to go into surgery. You will almost never see an unusual bone lesion unless it’s academia. You could potentially escape call since there is no true MSK emergency.
 
LP/myelo on a 400-500 lb pt is harder than the hip or shoulder arthrogram on the same size pt. I’ve done them both so I know.
Also I was* an ultrafast neuro reader and that is dangerous. My MSK colleague/best friend is an ultrafast MSK reader and he can continue to churn out 100+ MRIs a day since he knows his misses will not be too* detrimental to the patient (Whoever died from a meniscus tear?)
 
My 2 cents.

[ranweiss]

Quote from Radguy123123

Neurorad here. Same situation many years ago. Don’t do neuro. If you miss a very small finding it is catastrophic for the patient. You will always be needed for call purposes (stroke, bs cauda equina)

As for MSK, what is the worse that can happen? Pt will continue to experience pain. Experienced orthopods don’t need your read whether or not they decide to go into surgery. You will almost never see an unusual bone lesion unless it’s academia. You could potentially escape call since there is no true MSK emergency.

LP/myelo on a 400-500 lb pt is harder than the hip or shoulder arthrogram on the same size pt. I’ve done them both so I know.
Also I was* an ultrafast neuro reader and that is dangerous. My MSK colleague/best friend is an ultrafast MSK reader and he can continue to churn out 100+ MRIs a day since he knows his misses will not be too* detrimental to the patient (Whoever died from a meniscus tear?)

My 2 cents.

 
Reading 100 mri’s a day is far too much, and almost unsafe. 
 
I’m neuro, was private practice for 2 years, now in a more hybrid employed / rvu related job – Neuro is fine. You generate a lot of rvu’s for the group. Depending on your practice setting, if not academia, tends to be pretty bread and butter stuff.
 
I don’t find the job hard at all. Still clearing 6xx – 7xx on income level. 
 
Can’t go wrong with either. Both in demand. Do what you enjoy. 

[btomba_77]

Sad to see where we are now as a profession
 
“Choose the subspecialty that allows you to show the greatest level of disregard for your patients without fear of medicolegal consequence.”
 
smh

[ranweiss]

Quote from dergon

Sad to see where we are now as a profession

“Choose the subspecialty that allows you to show the greatest level of disregard for your patients without fear of medicolegal consequence.”

smh

Dont think most people feel this way. Above poster obviously is an exception. 

[22002469]

Quote from ar123

Quote from Radguy123123

Neurorad here. Same situation many years ago. Don’t do neuro. If you miss a very small finding it is catastrophic for the patient. You will always be needed for call purposes (stroke, bs cauda equina)

As for MSK, what is the worse that can happen? Pt will continue to experience pain. Experienced orthopods don’t need your read whether or not they decide to go into surgery. You will almost never see an unusual bone lesion unless it’s academia. You could potentially escape call since there is no true MSK emergency.

LP/myelo on a 400-500 lb pt is harder than the hip or shoulder arthrogram on the same size pt. I’ve done them both so I know.
Also I was* an ultrafast neuro reader and that is dangerous. My MSK colleague/best friend is an ultrafast MSK reader and he can continue to churn out 100+ MRIs a day since he knows his misses will not be too* detrimental to the patient (Whoever died from a meniscus tear?)

My 2 cents.

Reading 100 mri’s a day is far too much, and almost unsafe. 

I’m neuro, was private practice for 2 years, now in a more hybrid employed / rvu related job – Neuro is fine. You generate a lot of rvu’s for the group. Depending on your practice setting, if not academia, tends to be pretty bread and butter stuff.

I don’t find the job hard at all. Still clearing 6xx – 7xx on income level. 

Can’t go wrong with either. Both in demand. Do what you enjoy. 

 
Yeah Radguy123123 setting up kind of an absurd scenario. Sure, I guess if you have to read 100 MRI+ per day, it’s “safer” to do MSK? But that’s a ridiculous situation to be in and not at all aligned with most groups (or patient safety).
 
People should just choose what they enjoy, who knows what the landscape will look like for the next 30 years. 
 
If you want to get granular in the near term, if you plan to take a job that pays per click or based on wRVUs, neuro will be better financially since you will almost surely be reading fewer X-Rays.
 
But payment models are always subject to change so I wouldn’t recommend someone take a fellowship because of that alone.